When you and your doctor don’t agree on what “healthy” means (Guest post)

I can tell you when I lost faith in the medical establishment’s sovereignty over my body. I was sitting in my doctor’s office and she was showing me a graph that showed “healthy” BMI as it relates to height. I was 16 years old, and I weighed about 175lbs. I was a vegetarian who ate steamed broccoli every day after school before taking my dog for brisk walks. I also ate lots of cookies and toast and secretly smoked lots and lots of cigarettes. As far as teenage habits go, I was probably on the overly responsible side of average, and I’d been chubby since puberty. She looked at me, and pointed to a spot on the graph.

“For your height…” she said “You should weigh about 100lbs”

I didn’t hear much of what she said after that. My eyes glazed over with a mixture of shame and shock. My doctor had just told me that to be healthy, I needed to reduce myself by nearly half. I thought about how I took gym every semester even though it wasn’t mandatory, and how I sometimes attended open practices for sports teams I wasn’t actually on, just to have some buddies to run around the track with. I thought about the kinds of changes I would have to make to my lifestyle to do what this person was telling me was “healthy” and I knew it wasn’t reasonable.

My mom enrolled me in Weight Watchers, and I lost some weight. I lost the most on the weeks when I went to punk shows and moshed for hours, and wasn’t totally faithful about my food journal. When the meetings before holidays were all about strategies for avoiding “cheating” when there were so many “bad” foods around, I was the person asking if it was really so terrible to eat stuffing once a year while everyone looked at me with derision. I clearly lacked their dedication to the project.

I did.

Don’t get me wrong, I hated my fat body. I loathed it. I felt hideous and horrible and unlovable and unworthy because that’s what I had been taught to feel about myself. I wanted to be thin so bad. But I also had this nagging feeling that something about the stories I had swallowed wasn’t quite right. In the moments where I could step outside my own brain I heard other girls – the girls whose “perfect” bodies I tried really hard not to ogle when changing for gym (because gay) – seemed to hate themselves as much as I did. At what weight, what BMI, what waist to hip ratio, what caliper measurement of fat rolls, what jeans size, could I possibly deserve to think I was a human being worthy of respect or care or love or pleasure or reasonable health care?

I’ve distanced myself from western medicine. I see a naturopath, an acupuncturist, and a therapist who does shiatsu and TCM. I’ve made some changes to my lifestyle and the ways I eat, none of which have the goal (or the result) of weight loss. I’m working on feeling connected to my body so I can notice when it needs to tell me something. I’m working on finding joy in my experience of my body, whether that’s through running further than I ever have, eating the most perfectly ripe avocado, finding the ways to sleep that result in actual rest, or giving myself lots and lots of great orgasms. I have come to believe that self hatred, and the urge to make ourselves ever-smaller (and quieter, more acquiescent, etc) is far more lethal than butter or chocolate or enjoying yourself. You caught me; I’m a hedonist.

But I found myself in a medical doctor’s office late in 2014 when all my non western health care practitioners agreed- I should get some tests done to check out my hormones, ovaries, and uterus. My periods have gone from seven days to nine days, then two weeks, and most recently THREE weeks. I spend several days each month incapacitated by pain and heavy bleeding. My body is telling me to pay attention; something is clearly amiss. So I asked for recommendations from friends, made some inquiries, and chose a doctor. I was sent for blood work and ultrasounds. According to the tests, I’m perfectly healthy. Healthier than he expected.

“I guess this is good news” I said. “that I don’t have endometriosis or PCOS or cancer or fibroids. But it’s also confusing news! What do I do now?”

He had two recommendations for me; hormonal birth control and weight loss. Neither of these are options I am interested in pursuing.

I use my body to get places. In the winter I walk, and the rest of the year I cycle. Most days I walk about 5k. Sometimes more, sometimes less. I do squats when I brush my teeth, and sometimes I do planks and stretching at home. I dance while I wash dishes. In the warmer seasons I am more likely to jog, hike, swim, and do other active stuff. I joined a boxing gym for a while last year, that was pretty cool. I don’t do those things because it’s “required”, or to punish myself for eating, or with the aim of losing weight. I do those things because they’re fun and they make me feel good, especially if I do them with friends. My approach to food is to eat lots and lots of plants, things easily identifiable as “food”, to cook for myself as much as possible, and to enjoy eating. It took me a long time to stop counting the WW points of everything I ate (about a decade. actually) and I am not going back to that slippery slop towards self hate.

He asked me if I wear running shoes when I walk. He told me I needed to raise my heart rate by a certain level, and probably I should sweat some. I’m 31 years old, and I was sitting in his office while he explained what exercise was.

I was livid. but I was also too frustrated to be articulate. I’m sure I sounded petulant and stubborn. I told him I needed to think more about my options before agreeing to any of his proposed solutions. The most interesting part was that for the first time, the idea of my body shrinking actually made me feel sad. It’s not just that weight loss is hard and emotionally complicated; I actually legitimately like my body, what it can do and how it looks. That sure feels healthy to me.

(bio) Carly is a 31 year old queer fat femme and white cis woman. She works in queer and trans youth sexual health in Toronto, and comes to this work from having investment in community building, body autonomy, youth agency and wisdom, intersectionality, trauma survivorship, and keeping people alive. She likes roasted vegetables and bitter foods, and hates cantaloupe and anything gelatinous. She thinks that leopard print is a neutral and that prisons should be abolished. Find her on twitter @crushslut.

15 thoughts on “When you and your doctor don’t agree on what “healthy” means (Guest post)”

Thank you for sharing this! I am so tired of people being told to pursue BMI like a holy grail – and not acknowledging that health is so much more than weight. Going to the doctor should not be a thing that causes us stress, it should be a thing where we consult experts who help us heal. Lots and lots of hugs for Carly and hoping she can find an option that isn’t one she prefers to avoid.

This article is really important, I feel like so many GPs and doctors really don’t understand individual differences when it comes to weight. Some people’s BMIs are off the charts just because they carry extra muscle…..yet they’re told they’re too fat even though they’re completely healthy. I wish women weren’t constantly being told to shrink when they don’t need to *sigh*

I’ve heard many times that BMI is not as accurate a method of calculating a healthy weight as many people think. I had a friend in high school who was 5’0” with a 26” waist and DD breasts. Despite being quite small (except for that one area) her boobs put her in the “obese’ category which was demonstrably ludicrous. She ultimately had a reduction to a B cup due to back problems, but she was seriously ticked off to be labeled “obese” when she took good care of herself and, at ~15, was very self conscious about her large chest. Anyway, good for you for finding a way to determine your own healthy weight. And yeah, boxing is REALLY fun and probably one of the best decisions I’ve made in the last year. 🙂

As someone who does see doctors in traditional medicine a lot (unfortunately), reading this I notice what stands out to me as one of the biggest problems- doctors aren’t taught to approach patients as a team to help them. They are there supposedly with all the correct answers and patients either do exactly as they are told or they are uncooperative and non-compliant. Seen here, this doctor just told you that the two solutions are birth control and weight loss rather than approaching each as a question of if it’s something you want to try and if not, what else could be considered. And when proposing weight loss he makes assumptions about your lifestyle first before asking you about it and more importantly how you feel about it.
Doctors certainly have their area of expertise, but so do all patients. No one is more an expert on how I am feeling or what works for my life than I am. Certainly not someone who sees me only for the short window of time as a doctor appointment. Yet doctors typically disregard this type of expertise that patients bring.

Wow! I do have to say that it was pretty foul for that doctor to kind of make fun of you by asking if you wore sneakers for your workout. I, myself lost 75 pounds and it was not easy at all. That doctor was not ethical at all. On the other hand you are an inspiration to others 🙂

Wow. Healthcare providers should not be chastising their patients. Instead, they should be engaging them in their healthcare. Gone are the days of doctors making decisions and patients just taking one green pill and one white pill everyday. Now healthcare teams including doctors, pharmacists, and nurses are asking patients what they want and what their goals are. Your healthcare provider should be on your team.

I get a little sad when doctors only have these options. I could stand to lose a few pounds (not overweight, even by BMI-standards, but short and busty, so look a little heavy). I also have the same symptoms (heavy PMS, heavy bleeding, nauseating cramps), and my doctor also recommended either birth control or exercise. I don’t want to use hormonal birth control, and when I said I exercise enough (I run 3x 10 km a week, swim twice a week, do all sorts of other stuff, and bike everywhere), that became the problem. Now I exercise too much. Pick a lane dude, and no, I don’t.
BTW, I found that accupuncture helped aleviate the probem. Good luck.

May I say something?: My sister is a physician. She lost 50 lbs. and then regained probably 20 lbs. after having 2 babies within 4 yrs. She faced this fact prior to pregnancies when she got a diabetes 2 reading in her blood tests. And she made sure her blood was tested…twice.

She probably would recommend some daily exercise and changes in diet. It sounded really wrong that the doctor expressed his advice in such a patronizing, limited way. I doubt very much she would expect every woman to be magazine model slim: she was raised by a mother who is approx. 30 lbs. overweight BUT has prepared healthy meals for 6 children when we were young for the past….40 yrs. So there is that living dichotomy that exists in our family.

Please remember: some Western medicine physicians are human beings also. They are not robots nor all jerks.

That’s horrible; I really, really think the hyperfocus on BMI is making doctors a lot worse at patient care. Especially of children.

(I weighed 160 when I was sixteen, having finally begun to see results from my 2-3 years of weightlifting. I weighed 175 by the time I was a freshman in college, though. Doctors have never given me any guff about my weight, for which I am grateful.)

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